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A recent report by the global advocacy organization Amnesty International painted a dire picture of the impact of the COVID-19 pandemic in Somalia. Based on interviews with health workers, government officials, and finance and debt relief experts, the report concludes that the government’s response to the pandemic has been “grossly inadequate.” But how bad is the situation really? Dr Mohammed AM Ahmed answers a few questions.
How has Somalia been affected by the pandemic?
He was hit hard. My colleagues and I have been following the situation since the first cases were reported in March of last year. We have conducted consecutive online surveys to assess compliance with COVID-19 preventive measures and its impact on Somalis between April 2020 and January 2021. These are still ongoing.
Strict containment measures have been introduced. These included closing schools, non-essential businesses, bars and restaurants, closing borders, banning large gatherings, restricting movement and imposing a curfew. The measures have had a devastating effect on day workers and low-income communities. Many Somalis depend on daily paid employment for their livelihood.
In addition to the health impact of morbidity and mortality, I think the consequences of the COVID-19 pandemic have been more dire than the disease itself. Indeed, as in other low- and middle-income countries, there has been no government support for people. I wouldn’t be surprised if hunger kills more people than the virus.
According to officially confirmed cases, there were 16,831 at the start of September and 913 confirmed deaths. But the true burden of the disease is vastly underestimated. There are a number of reasons for this. But the main thing is that not all laboratories in the country are included in the count. In addition, only a few labs can test for COVID-19.
What were the biggest obstacles?
The biggest obstacle is that the country has not been able to establish a strong health system due to three decades of civil war. Access to basic health care is limited.
Nonetheless, the response from the Somali government has been very good. The Ministry of Health, in collaboration with international organizations, has worked hard to put in place a comprehensive plan.
The government has formed a COVID-19 task force. It also issued travel restrictions for passengers from high-risk countries, prepared and set up 14 institutional quarantine sites and dedicated a hospital to deal with emergencies requiring ventilation.
Preventive measures included closing academic institutions and banning large-scale social gatherings.
Despite these efforts, the number of cases continued to increase.
The pandemic has found Somalia in a rebuilding phase, with most of the population living in overcrowded and poorly constructed houses and large camps for internally displaced people with limited access to testing and health care.
Our initial observations were that many preventative measures were being ignored due to strong cultural or religious beliefs. For example, people continued to gather in mosques several times a day for prayers and to attend funeral services without proper personal protective equipment.
What action does the government need to take?
The government needs to strengthen health infrastructure so people can get basic emergency health care.
It should also establish a public health surveillance system that initiates the continuous and systematic collection, analysis and interpretation of health-related data.
Most health care in the country is privatized. The World Health Organization estimates that around 80% of the needs for drugs and health products are met by the private sector. The sector is poorly regulated and concentrated in urban areas. But I believe that the private health sector can contribute to better access to care if it is operationalized, organized and regulated. It is therefore necessary to integrate health information between the two sectors. Without it, the numbers will continue to be underreported.
Having this type of data would allow:
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serve as an early warning system for impending epidemics
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allow the monitoring and evaluation of the impact of an intervention
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help monitor progress towards specified goals
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monitor and clarify health issues, which in turn will guide the setting of priorities, planning and evaluation of public health policies and strategies.
In a recent study, my colleagues and I assessed the acceptability of the COVID-19 vaccine. Most of the participants – 76.8% – said they would agree to the vaccination. Those interviewed were mainly young people and were not eligible for the vaccine. Vaccination is reserved for high-risk groups. These include the elderly, healthcare workers and people with co-morbidities. Therefore, the government should push for more vaccines to be available for those who wish to be vaccinated and not just for high-risk groups. In Somalia, young people make up the bulk of the population. People over 65 represent only 3%.
Mohammed AM Ahmed does not work, consult, own stock or receive funding from any company or organization that would benefit from this article, and has not disclosed any relevant affiliation beyond his academic appointment.
By Mohammed AM Ahmed, Senior Lecturer and Director of Project Advancement for Medicine and Health Sciences, University of Mogadishu
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